Ulcers, how to treat? (tried nexium)

[reithme2]

Roughly six weeks ago I noticed my OTTB was acting girthy, pinning his ears when I put his saddle on/girthed up. Because he’s had ulcers in the past I immediately thought that may be the reason. Due to some threads on the forum regarding nexium I thought I’d give that a try and added nexium to his supplements.

I added 2 nexium capsules to his supplements for a month and didn’t noticed any difference. In fact I recently scheduled the saddle fitter to come out and reflock his saddle assuming that must be why he’s been girthy. Then tonight after I rode and cooled him out I threw him in his stall and gave him his tub of grain/beet pulp and instead of devouring it he almost immediately laid down… for him this is a classic ulcer symptom. So now I know he does have ulcers.

My questions…

Does Nexium not always work? Should I restart him on nexium and increase the dose to 3 or 4 capsules? I had added the capsules to his supplements and the BM had been throwing them in with his grain and beet pulp mash, perhaps he wasn’t really getting most of the capsules? They mix his feed in a wide, short tub and he is a messy eater and could easily have pushed the capsules out?
Have people tried putting them in fig newtons or bananas (hes a huge banana fan) to ensure the horse is getting the capsules? Empty the capsules in applesauce and use a syringe?

Should I give up on nexium and try to get some generic gastroguard/ulcerguard? Does anyone have a good source for this? Previously, I’d bought some generic omeprazole from a friend of a friend but can’t remember where they’d ordered it from.

Any ideas/advice are appreciated. I have nexium and obviously its the easiest to obtain and cheapest method but dont want to try again if it may not be working for him. I’d also like to avoid the high cost of gastrogard/ulcerguard if possible.

Thanks!

[joiedevie99]

Scope the horse and get a vet involved. Gastroguard alone works great on ulcers on the non-glandular region of the stomach. It works poorly on glandular stomach ulcers - which often need much longer terms of treatment, and other drugs to help (like sucralfate and misoprostol). It does nothing for hind gut ulcers, and may actually make them worse (since raising the ph of the stomach allows more undigested food to pass into the intestines).

[scruffy_the_cat]

I’d scope. BUT… do know that the equivalent of a tube of Ulcergard is 14 capsules of Nexium. So 2 capsules might not do anything. Anecdotally I did find that Nexium did have an effect on hindgut ulcers for my horse and there’s some literature to support that as well.

Also know that pinning ears while girthing up could be a back pain issue.

[NaturalSelection]

The Nexium study referenced in another COTH thread using 60 mg/day to treat a horse is a single study, small sample size, and only measures pH in the stomach 6 hrs after administration.

My horse showed symptoms of ulcers and was confirmed by scoping in late December. I did some additional research and found another study on Nexium that indicated 0.5 mg/kg could hold pH >5 for 18 hrs (14 capsules/day). This is the dosing that Scruffy references above. I have been treating my horse with that dose for 35 days and will be ready to rescope in about a week.

I’m still holding my breath as these off label Nexium studies are small and don’t demonstrate ulcer resolution by scope. In addition, even if the visible ulcers are resolved, I’m considering using Succeed or Sucralfate (per vet recommendation) to treat for hindgut ulcers as my horse still seems uncomfortable.

Good luck, ulcers can be difficult and expensive to treat.

[reithme2]

Thanks for the input. Scoping is an option but I would like to try other options first. Ive had this horse a long time and he isn’t bashful when it comes to letting you know when hes hurting which is really helpful when trying different treatments. If the nexium or omeparzole don’t work I will definitely look to having him scoped for hind gut, etc.

I’ve treated this horse with omeparzole in the past with great success and don’t have any reason to believe this would be different. I just figure nexium maybe easier (more accessible, could start him on it tomorrow) and cheaper alternative but am willing to go with omeparzole.

@NaturalSelection how are you feeding 14 capsules a day? Does you horse easily consume the capsules in their grain?

[Simkie]

Scope the horse.

[scruffy_the_cat]

I fed the 14 capsules with breakfast and both horses that I did this with just ate them. I did the typical ulcer protocol of 30 days at full dosage, then titrated down very slowly.

That being said, I really appreciate the information scoping can give.

[IPEsq]

On advice from my vet (who was aware of study 2 but not study 1), I also did the 0.5mg/kg dose with my horse for one treatment course and it seemed to work. I did have some ulcergard tubes on hand then as well but didn’t do near the full month with UG. I also liked the ability to taper more carefully with Nexium.

[stryder]

You can also use ranitidine. It’s best 3x a day, but 2x per day will work. Sucralfate works, but adding birch bark helps.

[AMackechnie]

I would advise, as others have, to involve your veterinarian and to have the horse scoped. A certain diagnosis and vet recommended treatment could have the horse on the way to a more comfortable existence much sooner than trying other solutions on your own.

[cnd8]

Scope is only way to know for sure. And it gives idea of what treatment is needed also. Scope is needed. Then, likley, Gastrogard.

[reithme2]

Vet is involved and recommended omeparzole as treatment as we’ve done in the past. I mentioned the nexium and while she hadnt heard of the study she thought it was interesting and ‘worth a shot’.

I started horse on 14 nexium capsules a day this AM. He was up, bright eyed and nickering for grain. He seemed to eat the grain plus capsules with no issues so hope that continues. Will consider scoping based on results but have a hard time justifying the cost to scope when it may very likely reveal what I already know and to continue doing what I’m already doing.

Thanks

[NaturalSelection]

I add the 14 capsules/day to nightly grain, horse eats them, no problem.

My vet hadn’t seen either of the Nexium studies, but also took the “why not” approach to 0.5 mg/kg dosing.

[scruffy_the_cat]

FWIW, my former horse actually got worse on Gastroguard. He only improved on Nexium (I used generic). We did also try the sucralfate route. But it was esomeprazole and management changes that ultimately fixed the issue. For management changes we made sure he had hay available all night, hay before breakfast, less grain, and more beet pulp.

[reithme2]

Thanks @NaturalSelection
Interesting @scruffy the cat
My BM was really surprised to hear I’m treating for ulcers as we’ve made sure to keep him on free chioce hay, he hasnt been off the property in several months and his routine and feed haven’t changed. He also has seems in good spirits, excited to eat, other then some mild symptoms (compared to previous ulcer bouts). Hoping I’ve caught it early and the nexium will do the trick.
Strange too that his ulcers only seem to rear up in the winter around this time, but not every year. I’m not sure what we could change management wise as a preventative. He is already on an ulcer prevention supplement in addition to free choice hay, beetpulp and grain.

[IPEsq]

Mine seems more prone to flare ups in spring and fall despite not changing anything else in his routine. Only takes a few hours of the right conditions I guess.

[CPL713]

Just my $0.02 after going down the ulcer rabbit hole for the last year…

I recommend scoping at this point. (Actually, I recommend scoping as soon as someone suspects ulcers.) I didn’t scope and kept throwing money at treatment that didn’t seem to work long-term. Involved another vet who basically said, “hey, before you throw MORE money at medication, let’s scope and make sure we know what we are dealing with and what we need to do”.

That way, you will know what type of ulcer you are dealing with, the severity, and the location – all of which can impact the treatment method you will want to use. (Gastrogard, ranitidine, nexium, sucralfate, whatever your vet and you decide – but I would have saved a LOT of money if I had scoped first instead of taking the “well it can’t hurt to try this” method.)

For me, scoping was well worth the cost because what I was doing wasn’t effective. It sounds like that might be where you’re at right now, as well.

[beowulf]

Scoping is always worth the cost because, if you don’t know what you are dealing with you will not know how to treat it. So you will keep dumping money into treating, and it will not help the horse. And in some cases, it can harm the horse as the behaviors and pain gets worse, leading to either residual behaviors, or secondary complications.

There’s thousands of reasons that horses get ulcers - and they will always continue to get ulcers until the management is changed, and the reason for the ulcers’ development is understood in the first place.

Could be anything from DGE to… something very, very serious. Scope the horse. If the horse has DGE, no amount of ulcer treatment will fix the ulcers until you adjust the diet…

I’m amazed that people treat ulcers and never change the management. Maybe it is that they can’t, in some boarding situations, but treating is not a one-and-done deal and in my experience the horse continues to get ulcers until the management is adjusted. Unfettered, actual 24/7 hay access (none of that “free choice” buzzwords that BMs throw around that translates to “oh he gets ~5 flakes of hay in his stall when I bring him in at 5PM, but that’s all until 7 AM… that’s free choice, right?!”) as in, hay in front of the horse at all times, quality grain (or none at all), and full turnout. The second you remove any of these from the equation is the second you jeopardize the horse to develop ulcers again.

[reithme2]

I’m not sure why I’m defending my choices here. I try to do right by my horse as much as I can, but here goes.

My horse has access to hay 24/7, as in ‘at all times’. Yes, most boarding places don’t do this, but knowing my horse I looked high and low and pay a premium for 24/7 access to quality hay. I dont think we could maintain his weight without some grain, but have cut back and replaced calories with beetpulp and oil. Other than that, yes I am limited, 24/7 turnout isn’t an option but the care he receives is excellent and hes turned out daily for 10-16 hours.

I appreciate the many opinions to scope and have noted multiple times I am open to scoping but do plan to wait until after the nexium treatment to make that call.

While he has presented with ulcer symptoms previously it was 2-3 years ago and was treated quickly (he improved within a few days, but did continue treatment for 30 days) and effectively (obvious improvement no issues after) with generic gastroguard/ulcerguard (omeprazole).

So far I’ve spent $20 and plan to spend another $120 on generic nexium for the 30 day nexium treatment so don’t feel i’ve quite gotten to the point of throwing money away and this hasnt turned into a persistent issue.

In making decisions for my horse I have to consider I’m on a budget, I have a healthy savings but try to only touch it for emergencies. If i dipped into savings at every possible sign of something being wrong with my horse I likely wouldn’t have a nice savings account to fall back on. So yes, I often take the wait and see approach or try a cheaper method first.

In conclusion, I may scope, I may not, that wasn’t the question.

[CPL713]

I don’t think anyone is attacking your choices or asking you to defend them, just sharing our experience after having gone through what you’re going through in an attempt to be helpful. Sorry if I came off that way. I read the latter part of your post as, “I’ve tried Nexium, should I give up on that and do you all have any other ideas if I do?” and that is the portion I have experience with and was responding to. It sounded like you’d been through all of this before with this horse, so I assumed you had already dropped some money into this over time.

I can tell you that all vets I’ve consulted who I trust on the matter say that for ulcers, the only treatment that they felt truly works for the type of ulcer I’m assuming your horse has is actual Gastrogard. I’ve used generic omeprazole/ranitidine in the past, but got it through my former vet so I don’t have a good suggestion on where else to get that, other than your vet. Or just stick with the Nexium at a higher dose for now, then taper off, and see if it appears to help, which is what it sounds like you are doing.